The Department of Human Services and the Affordable Care Act

The Department of Human Services (DHS) has successfully implemented provisions of the Affordable Care Act (ACA) and expanded access to affordable health insurance for Hawai‘i’s residents. The ACA gives states the primary responsibility for implementing most of the changes required under the Act.

As it relates to ACA, the key DHS function has been to design and build a new electronic eligibility system. The DHS Med-QUEST Division (MQD) is the project leader. The new system, called KOLEA, determines eligibility for advance premium tax credits and cost share reductions, which are applied towards the purchase of individual policies under ACA, and partially offset premium costs. Tax credits and cost share reductions make the health plans more affordable for modest-income individuals purchasing insurance through The Hawaii Health Connector beginning in 2014.

Medicaid is a federal/state partnership with shared authority and financing. The program covers nearly 50 million low-income Americans, including more than 285,000 Hawai‘i residents. States must meet minimum federal requirements such as covering families with children and offering certain benefits. States also may provide optional expanded coverage.

With the ACA Medicaid expansion beginning in 2014, any adult under 65 years of age with qualified residency or citizenship and income under 138% federal poverty level (FPL), will be eligible for Medicaid irrespective of their assets.

Also beginning in 2014, the ACA requires states to provide Medicaid coverage for former foster youth who are under age 26. Hawai’i is seeking federal approval to begin covering this group of former foster youth a year early, in 2013.